Lukana Preechasuk

Aims: We investigated the characteristics of typical adult‐onset type 1 diabetes (T1D) and insulin‐dependent latent autoimmune diabetes in adults (LADA) in Thailand. Methods: This retrospective chart review enrolled typical T1D and insulin‐dependent LADA patients diagnosed at age ≥30 years, and who were followed up at Siriraj Hospital, Thailand, during 2014–August 2024. Potential patients were searched from the Type 1 Diabetes Registry of Siriraj Diabetes Center and electronic medical record. Results: Among 84 patients, 32 were typical T1D and 52 LADA. At diagnosis, both groups had normal body mass index (20.9 ± 4.5 kg/m ² ), significant weight loss (13.3 ± 6.4%), short duration of hyperglycemic symptoms (1 [1–2] months), and high fasting blood glucose (259 [174–345] mg/dL). Diabetic ketoacidosis (DKA) was the first presentation in 76.7% of typical T1D and in 2.6% of LADA. Anti‐glutamic acid decarboxylase (anti‐GAD) was tested in 91.7% of patients (positive: T1D 72%, LADA 100%). Almost 70% of patients with LADA were initially misdiagnosed as T2D and were ultimately diagnosed at 7.6 [2.6–17.5] years later. Patients with LADA had a higher incidence of recurrent DKA. At latest follow‐up, patients with LADA had significantly higher systolic blood pressure (SBP), glycated hemoglobin (HbA _1c ), and insulin resistance compared to typical T1D. Conclusions: We found a higher proportion of LADA than typical T1D, and 70% of LADA were initially misdiagnosed as T2D. Both groups were characterized by a normal BMI, significant weight loss, and a short duration of hyperglycemic symptoms. However, LADA rarely presented with DKA and had higher HbA _1c and insulin resistance during follow‐up.

Neonatal hypoglycemia (NH) is potentially life-threatening and can lead to long-term neurological sequelae. We retrospectively assessed the association between maternal glycemia in women with type 1 diabetes (T1D) and NH. Continuous glucose monitoring data from 60 mothers, alongside routine capillary blood glucose measurements from their neonates, were analyzed. The analyses used two clinically recognized thresholds for NH (P = 0.019), a higher proportion was exposed to antenatal corticosteroids (31.6% vs. 7.3%, P = 0.014), and a higher proportion required admission to the neonatal intensive care unit (42.1% vs.12.2%, P = 0.009). Similar associations were observed for NH P = 0.01) and percentage time in range (OR 0.951, 95% CI 0.914–0.989, P = 0.01) as significantly associated with NH <2.2 mmol/L. Our data suggest that careful optimization of glycemia early in pregnancy, rather than in the final trimester alone, may help minimize the risk of NH in infants born to mothers with T1D.

Purpose: The optimal plasma lipoprotein(a) [Lp(a)] cutoff level for predicting atherosclerotic cardiovascular disease (ASCVD) in Southeast Asian populations remains limited. Therefore, our study aimed to identify the optimal plasma Lp(a) cutoff for predicting ASCVD in Thai patients. Patients and Methods: We conducted a retrospective analysis of patients who underwent Lp(a) measurement at Siriraj Hospital between January 2019 and August 2024. Inclusion criteria included Thai ethnicity and age ≥ 15 years. Baseline characteristics, comorbidities, laboratory data, and Lp(a) levels were extracted from medical records. Lp(a) levels were compared between ASCVD and non-ASCVD groups. Odds ratios (OR) for ASCVD and coronary artery disease (CAD) were calculated using Lp(a)< 25 nmol/L as the reference. Results: A total of 2341 patients (age 54.4± 17.7 years, 42.0% male) were included. Among them, 413 (17.6%) had ASCVD, 254 (10.9%) had CAD, 186 (7.9%) had ischemic stroke, 21 (0.9%) had peripheral arterial disease (PAD), and 14 (0.6%) had abdominal aortic aneurysm. Median Lp(a) levels (nmol/L) were significantly higher in patients with ASCVD [37.2 vs 24.4, p< 0.001], CAD [43.8 vs 24.5, p< 0.001], and AS [51.6 vs 25.3, p=0.002] compared to those without diseases. After adjusting for other risk factors, Lp(a)≥ 40 nmol/L was associated with increased risks of ASCVD [OR 1.538 (1.203– 1.958)] and CAD [OR 1.877 (1.407– 2.505)]. A multivariate model incorporating Lp(a)≥ 40 nmol/L with other risk factors demonstrated 70– 80% sensitivity and specificity for predicting ASCVD and CAD. Conclusion: Elevated plasma Lp(a) levels are significantly associated with ASCVD and CAD. An Lp(a) cutoff of≥ 40 nmol/L predicted ASCVD and CAD risk in Thai.

Type 2 diabetes is a heterogeneous disease with strong genetic components. We showed earlier that newly diagnosed type 2 diabetes in Thai patients could be categorized into four clusters. This study aimed to determine the evidence of hereditary factors in these type 2 diabetes clusters. A total of 487 subjects who were diagnosed with type 2 diabetes in two years were enrolled in the Siriraj Diabetes Center, Siriraj Hospital Bangkok, Bangkok, Thailand. They were divided into four clusters as previously described. The associations between patients' characteristics, degree of family history of diabetes (FHD), and type 2 diabetes clusters were tested using multinomial logistic regression. Among four clusters of newly diagnosed type 2 diabetes, there were significant differences in characteristics at baseline, including age at diagnosis, BMI, waist circumference, blood sugar levels, vital signs, triglyceride, HDL, calculated LDL, creatinine and eGFR (all p < .05). A relatively young age at the time of diabetes diagnosis was associated with having second-degree relatives with diabetes (p < .05) in all clusters when using mild age-related diabetes (MARD) cluster with no FHD as a control. Patients in the severe insulin-deficient diabetes (SIDD) cluster had more first-degree relatives with diabetes (odds ratio = 1.85; p = .0354), while patients in the metabolic syndrome diabetes (MSD) cluster (odds ratio = 10.73; p < .001) and the mild obesity-related diabetes (MOD) group (odds ratio = 6.66; p = .002), had more second-degree relatives with diabetes. Genetic factors might have various roles in the pathogenesis of type 2 diabetes, at least in newly diagnosed Thai patients. Our findings supported that genetic heterogeneity contributed to clinical heterogeneity or four different clusters. Further studies are needed in a larger sample size of these patients is needed to identify genetic loci associated with each cluster.

Aims: This study is aimed at evaluating the accuracy and feasibility of real‐time continuous glucose monitoring (rt‐CGM) in non‐ICU hospitalized adult COVID‐19 patients who had hyperglycemia requiring insulin therapy during admission. Materials and Methods: Medtronic Guardian Sensor 3 and transmitter were placed on the patient’s abdomen. The patient performed a self‐calibration of CGM via the application installed in the smartphone. Paired CBG and sensor glucose values were analyzed for accuracy of CGM using mean absolute relative difference (MARD) and Clarke error grid analysis (CEGA). Results: Fifteen patients were enrolled. Mean age was 48.6 ± 17.9 years; 53.3% were female. Thirteen patients (86.7%) had pre‐existing diabetes. Mean HbA1c was 10.6 ± 3.6 % . Mean duration of CGM use was 6 ± 1.2 days, and mean calibration was 2.6 ± 0.7 times/day. There were 253 paired CBG and CGM measurements. The overall MARD was 9.9 ± 9.3 % . The lowest MARD was observed in the CBG range of 70–180 mg/dL (9.6 ± 9.0 % ) and on Day 3 of sensor wear (8.0 ± 4.6 % ). The percentages of glucose readings within 15/15%, 20/20%, and 30/30% were 81.0%, 89.7%, and 95.3%, respectively. A total of 99.2% of the data points were in Zones A and B of CEGA, and none were in Zone E. CGM reduced POC testing by approximately 30%. Conclusions: Rt‐CGM use in hospitalized patients with COVID‐19 infection demonstrates high accuracy, reduces the frequency of CBG testing, and preserves medical resources. The patient’s self‐calibration of rt‐CGM in this setting is feasible. Although the COVID‐19 pandemic tends to improve, our research could be applied to new emerging infectious diseases. Trial Registration: Thai Clinical Trials Registry: TCTR20230426007.

Differences in the effectiveness of real-time continuous glucose monitoring (rtCGM) and intermittently scanned continuous glucose monitoring (isCGM) in type 1 diabetes (T1D) are reported. The impact on percent time in range of switching from an isCGM with glucose threshold-based optional alerts only (FreeStyle Libre 2 [FSL2]) to an rtCGM (Dexcom G7) with an urgent low soon predictive alert was assessed, alongside other secondary outcomes including hemoglobin A1c (HbA1c) and other continuous glucose monitoring metrics. Adults with T1D using FSL2 were switched to Dexcom G7 for 12 weeks. HbA1c and continuous glucose data during FSL2 and Dexcom G7 use were compared. Data from 29 participants (aged 44.8 ± 16.5 years, 12 male and 17 female) were analyzed. After switching to rtCGM, participants spent less time in hypoglycemia below 3.9 mmol/L (70 mg/dL) (3.0% [1.0%, 5.0%] vs. 2.0% [1.0%, 3.0%], P = 0.006) and had higher percentage achievement of time below 3.9 mmol/L (70 mg/dL) of P = 0.005). Coefficient of variation was lower (39.3 ± 6.6% vs. 37.2 ± 5.6%, P = 0.008). In conclusion, adults with T1D who switched from isCGM to rtCGM may benefit from reduced exposure to hypoglycemia and glycemic variability.

Intensive lifestyle interventions are effective in preventing T2DM, but evidence is lacking for high cardiometabolic individuals in hospital settings. We evaluated a hospital-based, diabetes prevention program integrating cognitive behavioral therapy (CBT) for individuals with prediabetes. This matched cohort assessed individuals with prediabetes receiving the prevention program, which were matched 1:1 with those receiving standard care. The year-long program included five in-person sessions and several online sessions covering prediabetes self-management, dietary and behavioral interventions. Kaplan–Meier and Cox regression models estimated the 60-month T2DM incidence rate. Of 192 patients, 190 joined the prevention program, while 190 out of 10,260 individuals were in the standard-care group. Both groups had similar baseline characteristics (mean age 58.9 ± 10.2 years, FPG 102.3 ± 8.2 mg/dL, HbA1c 5.9 ± 0.3%, BMI 26.2 kg/m², metabolic syndrome 75%, and ASCVD 6.3%). After 12 months, the intervention group only showed significant decreases in FPG, HbA1c, and triglyceride levels and weight. At 60 months, the T2DM incidence rate was 1.7 (95% CI 0.9–2.8) in the intervention group and 3.5 (2.4–4.9) in the standard-care group. After adjusting for variables, the intervention group had a 0.46 times lower risk of developing diabetes. Therefore, healthcare providers should actively promote CBT-integrated, hospital-based diabetes prevention programs to halve diabetes progression.

Objective: To explore the effect of diabetes self-management education and support (DSMES) provided by Siriraj certified diabetes educators (CDE) compared to usual diabetes education (DE) on glycemic level and stage of behavior change in patients with type 2 diabetes mellitus (T2D). Materials and Methods: Patients with T2D having A1C 8-12% were recruited between 2019-2020 to receive DSMES from CDE. Patients received the usual DE from healthcare professionals in 2016 were randomly selected from their medical records. Results: 76 patients were enrolled in each group. Mean±SD age was 59.4±11.5 years. After receiving DSMES and DE, A1C decreased dramatically at 3 months in both groups without significant difference between the groups (9.4±1.1% to 8.0±1.2% vs. 9.5±1.1% to 8.1±1.5%, respectively). However, the DEMES group can further decrease A1C to 7.8±1.2% while A1C in the usual DE group increased to 8.5±1.6% at 12 months (p=0.028). In the DSMES group, most patients can move to the next stage of behavior change and reported a better QOL (89.4±11.6 vs. 92.6±12.2, p=0.018). Conclusion: The receipt of DSMES from CDE significantly improved the level of A1C, the stage of behavior change, and QOL. Its benefit on the glycemic level can last at least one year.

Purpose Allulose is a rare monosaccharide with almost zero calories. There is no study of short-term allulose consumption in patients with type 2 diabetes (T2D). Thus, we aimed to study the effect of allulose consumption for 12 weeks on glucose homeostasis, lipid profile, body composition, incretin levels, and inflammatory markers in patients with T2D. Methods A double-blind, randomized, controlled crossover study was conducted on sixteen patients with T2D. Patients were randomly assigned to allulose 7 g twice daily or aspartame 0.03 g twice daily for 12 weeks. After a 2-week washout, patients were crossed over to the other sweetener for an additional 12 weeks. Oral glucose tolerance tests, laboratory measurements, and dual-energy X-ray absorptiometry were conducted before and after each phase. Results This study revealed that short-term allulose consumption exerted no significant effect on glucose homeostasis, incretin levels, or body composition but significantly increased MCP-1 levels (259 ± 101 pg/ml at baseline vs. 297 ± 108 pg/mL after 12 weeks of allulose, p = 0.002). High-density lipoprotein cholesterol (HDL-C) significantly decreased from 51 ± 13 mg/dl at baseline to 41 ± 12 mg/dL after 12 weeks of allulose, p < 0.001. Conclusion Twelve weeks of allulose consumption had a neutral effect on glucose homeostasis, body composition, and incretin levels. Additionally, it decreased HDL-C levels and increased MCP-1 levels. Trial registration This trial was retrospectively registered on the Thai Clinical Trials Registry (TCTR20220516006) on December 5, 2022.